Approximately 80% of women give birth within 5 years following a single miscarriage
No increased risk of subsequent pregnancy complications based on management choice
Recurrent pregnancy loss workup
Not recommended after a single loss
Indicated after 2 or more consecutive losses
Workup: antiphospholipid antibodies, karyotype both partners, thyroid function, uterine evaluation
Patient Discharge Instructions
copy discharge instructions
Discharge instructions for missed miscarriage
What happened
You were diagnosed with a missed miscarriage, also called a missed abortion
This means the pregnancy stopped developing but has not yet passed from the uterus
This is very common, affecting about 15 of every 100 pregnancies
Your management plan
Your doctor has discussed the three options: waiting for natural passage, medication, or a small procedure
Follow the specific plan your doctor prescribed for you
If given mifepristone: take it today, then take misoprostol as directed 24 hours later
What to expect
Bleeding and cramping are expected, often similar to a heavy period
Bleeding may last 1 to 2 weeks
Cramping is usually strongest in the first 24 hours after misoprostol
Take your pain medicine before the cramping starts
Return to the emergency department immediately if
Soaking more than 1 pad per hour for 2 hours in a row
Fever above 38 degrees Celsius (100.4 F)
Severe abdominal pain that is getting worse
Foul-smelling vaginal discharge
Dizziness, lightheadedness, or fainting
Signs of infection: chills, shaking, worsening pain
Follow-up
Attend your follow-up appointment in 7 to 14 days
An ultrasound may be done at follow-up to confirm complete passage
If you chose the medication approach, call your doctor if no bleeding begins within 24 hours of misoprostol
Emotional support
Miscarriage is a loss, and it is normal to feel sad, anxious, or grief
Talk to your doctor, midwife, or a counselor if you are struggling
Your partner, family, or friends may also benefit from support
Contraception and future pregnancy
Ovulation can return as early as 2 weeks after a miscarriage
Discuss contraception with your doctor if you are not ready to try again
Most women (about 80%) have a healthy pregnancy within 5 years after a miscarriage
References
Guidelines and key sources
ACOG Practice Bulletin No. 200: Early Pregnancy Loss
Obstetrics and Gynecology, 2018
Primary evidence-based guideline for management of missed abortion
Covers expectant, medical, and surgical management options
Doubilet PM, Benson CB, Bourne T, et al.
Diagnostic Criteria for Nonviable Pregnancy Early in the First Trimester
New England Journal of Medicine, 2013
Established definitive ultrasound criteria: CRL 7 mm, MSD 25 mm thresholds
Chu JJ, Devall AJ, Beeson LE, et al.
Mifepristone and Misoprostol Versus Misoprostol Alone for Missed Miscarriage (MifeMiso)
Lancet, 2020
RCT demonstrating superiority of combination regimen (83% vs 76% complete expulsion at 7 days)
Ghosh J, Papadopoulou A, Devall AJ, et al.
Methods for Managing Miscarriage: A Network Meta-Analysis
Cochrane Database of Systematic Reviews, 2021
Suction aspiration ranked most effective overall (SUCRA 92.7%)
Quenby S, Gallos ID, Dhillon-Smith RK, et al.
Miscarriage Matters: The Epidemiological, Physical, Psychological, and Economic Costs of Early Pregnancy Loss
Lancet, 2021
Comprehensive epidemiology and risk factor data
Prabhu M, Louis JM, Kuller JA
SMFM Statement: RhD Immune Globulin After Spontaneous or Induced Abortion Less Than 12 Weeks
American Journal of Obstetrics and Gynecology, 2024
Updated guidance on RhIg dosing in first-trimester loss
Expert Panel on GYN and OB Imaging, Laifer-Narin SL, et al.
ACR Appropriateness Criteria: First Trimester Vaginal Bleeding, 2025 Update
Journal of the American College of Radiology, 2025
TVUS rated "Usually Appropriate" as first-line imaging
Aronoff DM, Marrazzo JM
Infections Caused by Clostridium Perfringens and Paeniclostridium Sordellii After Unsafe Abortion
Lancet Infectious Diseases, 2023
Clostridial sepsis recognition and management
Coomarasamy A, Gallos ID, Papadopoulou A, et al.
Sporadic Miscarriage: Evidence to Provide Effective Care
Lancet, 2021
Management evidence and future fertility data
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.